HRT Flashcards Preview

Y4 Important to learn > HRT > Flashcards

Flashcards in HRT Deck (18)
Loading flashcards...
1

What blood test levels are suggestive / diagnostic of menopause?

low oestradiol (<70 pmol/L) despite high LH and FSH 

2

Why do we try to avoid the systemic use of HRT?

It causes endometrial hyperplasia → possibility of malignancy

 

*therefore, if needed (symptom assessment/impact on life), use minimal doses for short period of time

3

How do we divide (2) the women patients for the purpose of treatment with HRT?

1. Those with uterus

2. Those who had a hysterectomy

4

What HRT would be recommended in a woman with a uterus who have bled within last year (perimenopausal)?

Cyclical combined HRT

(progesterone on the last 12 out 28 days)

Result: regular post-progesterone withdrawal bleed → protective for endometrium

* given for max 5 years (as prolonged use increases the risk of endometrial cancer)

* once a patient has been amenorrhoeic for 1 year / or reaches 54 → transfer to continous combined therapy

5

When do we change cyclical combined HRT into continuous combined HRT?

Once a patient has been amenorrhoeic for 1 year / or reaches 54 (whichever is sooner)→ transfer to continuous combined therapy

6

What HRT to prescribe for a woman with uterus, who has not bled for 1 year (postmenopausal) ?

Continuous combined HRT 

(continuous oestrogen and progesterone)

 

  • endometrial atrophy is caused → women should not bleed on that
  • progesterone protects the endometrium from hyperplasia (and reduces risk of endometrial cancer)
  • unwanted SEs of progesterone: withdrawal bleeds, premenopausal-like symptoms

7

Do we expect a bleed in a woman on continuous combined HRT?

  • endometrial atrophy is caused → women should not bleed on that

 

  • progesterone protects the endometrium from hyperplasia (and reduces risk of endometrial cancer)
  • unwanted SEs of progesterone: withdrawal bleeds, premenopausal

8

What HRT can we give in women who have had a hysterectomy?

Oestrogen only HRT

- doses can be titrated to their symptoms

- progesterone is not required → if hysterectomy, there is no risk of unopposed oestrogen-induced endometrial hyperplasia 

9

(3) indications for HRT

  • menopausal-related symptoms
  • early menopause
  • prevention of osteoporosis

10

 

  • Contraindications (strong) for HRT (4)

 

  • Relative contraindications for HRT

Strong:

  • endometrial cancer
  • liver disease (e.g. active hepatitis)
  • suspected pregnancy 
  • inherited thrombophilias 

 

Relative: (referral to specialist)

  • hypertension
  • previous personal or family Hx of thromboembolism
  • breast cancer

(close consideration for risk-benefit analysis)

11

Indications for specialist referral in terms of starting/not HRT

Relative contraindications: 

  • hypertension
  • previous personal or family Hx of thromboembolism
  • breast cancer

Other:

  • menopause before 40 yo
  • confirmed risk of osteoporosis
  • high risk of personal Hx of oestrogen-dependant ca (e.g. breast, endometrium)
  • abnormal bleed before the start of HRT/while using cyclical HRT or more than 6 months after start of continous combined HRT

12

MoA and use of Bisphosphonates 

- examples of drugs

MoA: inhibit the osteoclast-mediated bone resorption → prevent osteoporosis

Examples: Pamidronate and Alendronate

 

*oral calcium and vitamin D supplements often given in addition to bisphosphonates

13

What's Tibolone?

Tibolone

  •  synthetic steroid
  • agonist → oestrogenic, progestogenic and androgenic effects
  • Use: to relieve post-menopausal symptoms and protect the bones
  • it doesn't cause endometrial proliferation (but may cause irregular bleeding within few months)

14

What's Raloxifene

Raloxifene

  • new class of selective-oestrogen-receptor-modulators (SERMs)
  • MoA: selective stimulation of oestrogen receptors → to prevent osteoporosis and have beneficial effect on lipid profile
  • SERMs do not relieve menopausal symptoms

15

Benefits of HRT (3)

  • relieve in menopausal symptoms
  • 50% reduction in osteoporosis risk
  • it may delay onset of Alzheimer's (no effect on established disease)

16

Risks of HRT (4)

HRT increase risk of:

  • breast cancer
  • endometrial cancer
  • venous thromboembolism 
  • CVS disease (with combined HRT)

17

Do we follow up women on HRT?

Yes. Women on HRT should be followed up 6-monthly to:

- assess symptoms improvement

- assess side effects

18

Postmenopausal bleed (6-12 months after the menopause). What to do?

Immediate referral for endometrial biopsy